Wang Yijin, Metselaar Herold J, Peppelenbosch Maikel P, Pan Qiuwei
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Curr Opin Infect Dis. 2014 Aug;27(4):303-8. doi: 10.1097/QCO.0000000000000074.
Solid-organ recipients infected with hepatitis E virus (HEV) bear an extremely high risk of developing chronic hepatitis, although this virus only causes acute infection in the general population. Immunosuppressive medication universally used after transplantation to prevent organ rejection appears to be a main risk factor for developing chronic infection. This review aims to overview and emphasize the current clinical and experimental evidence regarding the key implications of immunosuppressants in chronic hepatitis E.
Over 60% of organ recipients who are infected with HEV develop chronic hepatitis. Immunosuppressant treatment after transplantation was identified as a key risk factor. Therefore, dose reduction or even withdrawal of immunosuppressants is considered as the first intervention strategy to achieve viral clearance in these patients. Otherwise, ribavirin, as an off-label medication, is considered as an antiviral treatment, with compelling outcomes observed so far. Interestingly, in addition to a common immunosuppression property that can favour HEV infection in general, different types of immunosuppressants may exert differential impacts on the infection course in patients. Furthermore, potential interaction may exist between particular immunosuppressant and ribavirin. With the recent development of a cell culture system for HEV, experimental research has been initiated to investigate how immunosuppressive drugs interact with HEV infection.
On the basis of the current evidence, it remains impossible to define an optimal immunosuppressive protocol for these HEV-infected patients. However, the realization of this clinical issue and the initiation of translational research using cell culture models of HEV have been represented as milestones in this field.
戊型肝炎病毒（HEV）感染的实体器官移植受者发生慢性肝炎的风险极高，尽管该病毒在普通人群中仅引起急性感染。移植后普遍使用的预防器官排斥的免疫抑制药物似乎是发生慢性感染的主要危险因素。本综述旨在概述并强调当前关于免疫抑制剂在慢性戊型肝炎中的关键影响的临床和实验证据。
超过60%的感染HEV的器官移植受者会发展为慢性肝炎。移植后的免疫抑制治疗被确定为关键危险因素。因此，减少剂量甚至停用免疫抑制剂被视为这些患者实现病毒清除的首要干预策略。否则，利巴韦林作为一种非适应证用药，被视为一种抗病毒治疗药物，目前已观察到令人信服的疗效。有趣的是，除了一般有利于HEV感染的常见免疫抑制特性外，不同类型的免疫抑制剂可能对患者的感染病程产生不同影响。此外，特定免疫抑制剂与利巴韦林之间可能存在潜在相互作用。随着最近HEV细胞培养系统的发展，已启动实验研究以探讨免疫抑制药物如何与HEV感染相互作用。
基于目前的证据，仍无法为这些HEV感染患者确定最佳免疫抑制方案。然而，认识到这一临床问题并启动使用HEV细胞培养模型的转化研究已成为该领域的里程碑。
